MEDICARE: DUBUQUE FAMILY PRACTICE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467411611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUBUQUE FAMILY PRACTICE, PC

Provider Business Mailing Address
First Line	:	320 N GRANDVIEW AVE
Second Line	:	SUITE D
City	:	DUBUQUE
State	:	IA
Zip	:	52001-6328
Country	:	US
Telephone Number	:	563-583-9300
Fax Number	:	563-589-2555

Provider Business Practice Location Address
First Line	:	320 N GRANDVIEW AVE
Second Line	:	SUITE D
City	:	DUBUQUE
State	:	IA
Zip	:	52001-6328
Country	:	US
Telephone Number	:	563-583-9300
Fax Number	:	563-589-2555

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LYNN KILGORE
Credential	:
Telephone Number	:	563-583-9300

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	08/22/2020

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